Explanation of conditions, investigations and management plans

Question 1

How would you explain the diagnosis of Type 1 Diabetes to a patient?

Answer 1

Type 1 diabetes is an autoimmune condition in which the body attacks the cells of the pancreas, meaning that it is unable to produce the hormone insulin. Insulin is very important for controlling the sugar levels in the body and so without this hormone there is loss of control of the sugar levels which can cause some of the symptoms you have been experiencing. Type 1 diabetes is a chronic condition, which means that it is life long, however with the appropriate management we can get it under control.

Question 2

What investigations and what management plan would you suggest to a patient with type 1 diabetes?

Answer 2

• Blood tests (autoantibodies and C-peptide)
• Glucose (sugar) measurements
• one of these would be a random measurement and the other would be done after a period of fasting)
• we will also look at blood levels to give us an indication of your sugar control over the past few months (HbA1c)

Insulin injections (4 times per day, esp before meals) 
Importance of regular monitoring and lifestyle advice about being careful with alcohol and exercise regimes

Question 3

How would you explain the diagnosis of hypothyroidism to a patient?

Answer 3

The thyroid gland sits in your neck and is responsible for the production of thyroid hormones. These hormones are important in helping the body regulate its energy. In your case i think you may have what is called hypothyroidism in which the gland does not produce enough of these hormones. The most common cause is autoimmune in which the body attacks the gland. This can be well managed with thyroid hormone replacements.

Question 4

What investigations and management plan would you suggest to a patient presenting with hypothyroidism?

Answer 4

General examination
Blood tests (to look at hormone levels)
US scan of the neck (this gives us a better idea of what is going on in the thyroid gland)

Thyroid hormone supplements

Question 5

How would you explain the diagnosis of hyperthyroidism to a patient?

Answer 5

The thyroid gland sits in your neck and is responsible for the production of thyroid hormones. These hormones are important in helping the body regulate its energy. In your case i think you may have what is called hyperthyroidism in which the gland does produces too much of these hormones. There are several different causes including autoimmune which is the most common, as well as recent illness and certain medications.

Question 6

What investigations and management plan would you suggest to a patient presenting with hyperthyroidism?

Answer 6

General examination
Blood tests (to look at hormone levels)
US scan of the neck (this gives us a better idea of what is going on in the thyroid gland)
ECG ( too look for AF if there is a history of palpitations)

Medications - carbimazole

Question 7

What safeguarding would you do when discussing management plans with a patient presenting with hyperthyroidism?

Answer 7

Check if they are pregnant or have any plans to start a family
Explain that some of the drugs which are used are contraindicated in pregnancy and therefore this is important to know about

Tell the patient that if they experience a sore throat, fever or feel unwell they should come back in as this is a possible side effect of one of the medications.

Question 8

How would you explain the diagnosis of cushings to a patient?

Answer 8

Cushings is a condition in which the body produces too much of a steroid hormone which is called cortisol. There are several different causes. It can be due to a tumour in the head on a small gland called the pituitary. It can also be caused by a tumour on the adrenal glands which sit just on top of your kidney. It can also sometimes be due to taking steroid medication or supplements. I understand that this may seem alarming at this point in time, but with the right management we can get it under control.

Question 9

What investigations would you suggest to a patient presenting with cushings?

Answer 9

I think the best next step today would be to do what is known as a suppression test. This is where we give you a medication and then monitor how much steroid hormone you produce over night.
If we have the right diagnosis you will carry on producing large amounts of the hormone, even when we have given you the suppressant.

It would also be appropriate to take some blood samples today and arrange an MRI scan to see if we can find the cause of the problem.

If the cause of the problem is coming from a tumour in the head, this can sometimes also affect vision and it would therefore be appropriate to test your vision today as well.

Question 10

What management options would you suggest to a patient presenting with cushings?

Answer 10

Explain that the management is dependent on what the cause of the problem is found to be.
Some of the options include medications to suppress the steroid production, or surgery to remove a tumour if this is found to be the cause.

Question 11

How would you explain the diagnosis of Addison’s to a patient?

Answer 11

Addison’s is an autoimmune condition in which the body attacks the adrenal glands which are two little glands which sit on top of the kidneys. This means that these glands can’t produce enough steroid hormones and this may account for how you have been feeling recently. The condition is chronic, which means it is life-long, however it can be well controlled with the right management.

Question 12

How would you explain the investigations and management plan to a patient presenting with Addison’s?

Answer 12

To investigate for the condition we would carry out a test which involves trying to stimulate your production of steroid hormone. We would do this by giving you a drug and measuring your hormone levels before and 30 mins after. This tests to see whether your body is able to produce its own hormone. If it can’t, then we would be thinking that Addison’s is the most likely diagnosis.

We would also want to take some blood samples today to check for other things (autoantibodies)

In terms of management, the most important thing is to replace the steroids which your body isn’t producing and we can do this by giving you medications to take. (hydrocortisone, fludrocortisone)

Question 13

How would you explain the diagnosis of PCOS to a patient?

Answer 13

Polycystic ovary syndrome is an inherited condition in which small cysts form on the ovaries. It can cause changes to your menstrual pattern and it may also affect hormone levels, causing some changes to the hair and skin.

Question 14

What investigations and management plan would you suggest to a patient presenting with PCOS?

Answer 14

Blood tests (hormone levels) 
US scan 

Weight loss if overweight
Medications, one of the possible options is the oral contraceptive pill, this helps to regulate the menstrual cycle
Surgery is an option to remove the cysts

Question 15

How would you explain the diagnosis of premature ovarian failure to a patient and how would you explain the investigation and management plan.

Answer 15

Premature ovarian failure involves the onset of the menopause at an earlier age than expected. It can be investigated by blood tests to look at the hormone levels and can be management with hormone supplements after that.

Question 16

How would you explain the diagnosis of kidney stones to a patient?

Answer 16

Kidney stones form when the waste products in the blood build up to form small crystals. These can accumulate to form stones which can cause blockages in the urinary tract. This is likely what is causing your pain. These often pass by themselves but there are also some things we can do to relieve your pain and make you more comfortable.

Question 17

Outline the investigations and management plan for a patient presenting with kidney stones

Answer 17

It would be suitable to take a urine sample and a blood sample, to rule out infection or any other causes. It may also be appropriate to do a CT scan so we can assess the size of the stone.
Most stones do pass by themselves but if the results of the investigations show that the stone is large, we may have to consider inserting what is called a stent.

So the next steps today would be to take some samples, refer you for a scan and then wait to see if the stones pass. If they don’t within a month we will consider other options.

Question 18

How would you safeguard when taking a history from a patient presenting with kidney stones

Answer 18

Stones often pass by themselves within a month. However if they don’t pass or you begin to feel unwell or have any signs of fever or nausea which could indicate infection, come straight back in.

Question 19

What are some of the extra questions to ask a patient if you suspect a diagnosis of kidney stones?

Answer 19

Have they ever had gout?

Have they ever taken or do they use steroid supplements?

Do they work? If so as what? (certain occupations e.g catering, are known to be hot environments where patients don’t drink enough)

Question 20

How would you explain the diagnosis of a urinary tract infection to a patient and what would you tell them in terms of investigations and management?

Answer 20

Urinary tract infections are very common, especially in women. They often clear within a few days but we can give you some treatment today to speed that up and make you feel a lot better.
It would appropriate today to take a urine sample to help us understand what’s causing the infection. We may also consider taking some blood samples but this might not be necessary at this point.
We can give you some antibiotics, this is usually a 3 day course. I would also recommend making sure that you drink plenty of water over this time.

Question 21

Safeguarding for a patient with a urinary tract infection

Answer 21

If you begin to feel unwell or have a fever or nausea, come straight back in, this this can indicate that the infection has progressed and so we would want to get this under control straight away.

Question 22

What are some of the extra questions to ask a patient if you suspect a urinary tract infection?

Answer 22

How much water/ fluids do they drink?

Are they sexually active?

Do they have any pain in the side, fever or nausea? (important to rule out pyelonephritis)

Question 23

How would you explain the possible diagnoses that may be causing incontinence in a MALE patient?

Answer 23

Incontinence is a very common problem. I understand that it can feel quite embarrassing but you really aren’t alone in this. There are several different things which can cause it and so it would be appropriate today to do some investigations to try and figure out what is going on.

Some of the possible causes include an enlargement of the prostate gland, an obstruction somewhere within the urinary tract or your bladder being overactive, meaning that it tells your body to go to the toilet when it’s not appropriate to do so.

So they are some of the possible causes, we can discuss more about how to investigate for these and how to manage them, but do you have any Qs for me at this point?

Question 24

How would you explain the investigations for a male patient presenting with incontinence?

Answer 24

I think it would be appropriate to do an abdominal exam to see if there is any evidence of your bladder being enlarged or any other signs we could pick up. I also think it would be necessary to do a rectal examination today, as this can allow us to feel the prostate gland. I understand that this is quite a sensitive examination so we can discuss further to give you a proper explanation of what it involves and allow you to ask you to ask any questions you might have.
Other tests i think would be relevant to day would be to take a urine sample and a blood sample.
It may also be necessary to refer you for something called urodynamics. This is a non-invasive test which allows us to assess how your bladder is functioning in terms of holding and releasing urine over a period of time.

Question 25

What would be the management options for a male patient presenting with incontinence’?

Answer 25

Decrease caffeine intake
Smoking cessation
Medications

Question 26

What would be some of the *extra questions you might ask a patient if you suspect a diagnoses of bladder cancer?

Answer 26

PMH of long term catheters
Smoking
Ever lived/ spent time abroad
Occupation (e.g hairdressers)

Question 27

How would you explain the investigations for a patient presenting with symptoms suggestive of bladder cancer?

Answer 27

I think it would be appropriate to take a urine sample from you today, as well as a blood sample. You can discuss this further with the GP, but i think that it is likely that they may consider referring you for something called cystoscopy. This is a procedure which is used to look into the bladder using a small camera. It may be a bit uncomfortable but a local anaesthetic is usually used for the procedure. I also think it would probably be appropriate to refer you for a CT scan, to give us a better idea of what’s going on.

Question 28

What investigations and management plan would you suggest to a patient presenting with symptoms suggestive of prostate cancer?

Answer 28

Abdominal examination
Rectal examination
Blood tests
MRI or CT scan

Medications
Radiotherapy/ chemotherapy
Surgery

Question 29

What important Qs should you add on to a history if you suspect AKI as the diagnosis?

Answer 29

Itch (think urea)
Any recent medical procedures (think contrast)
DH (ACE.I, antibiotics, diuretics, NSAIDs)

Question 30

What investigations and management plan would you suggest to a patient presenting with symptoms suggestive of AKI?

Answer 30

Urinalysis
Bloods
US scan

Give fluid
Stop nephrotoxic drugs

Question 31

What would be the list of new presenting symptoms to run through when taking a review history from a patient with chronic kidney disease?

Answer 31

Weight gain or loss 
Swelling 
Appetite, N&V 
Itch 
Urinary changes

Question 32

How would you explain the diagnosis of rheumatoid arthritis to a patient?

Answer 32

Rheumatoid arthritis is an autoimmune condition in which the body attacks the lining of your joints. This can cause pain and swelling and could explain how you’ve been feeling.

Question 33

What would you suggest in terms of investigations and management plan for a patient presenting with symptoms suggestive of rheumatoid arthritis?

Answer 33

Blood tests
X-ray or US scan

It is most effective to start patients on medication as soon as possible as this gives the best chance of getting the disease process under control.
(Steroids and DMARDs)

Folic acid supplements

Question 34

What extra Qs or topics would you bring up when taking a REVIEW history from a patient with rheumatoid arthritis?

Answer 34

Abdominal pain, changes in bowel habit, changes in the skin, itch, coughs/ colds, feeling run down
(potential side effects of methotrexate)

Pregnancy / contraception

Alcohol and smoking

LFTs

Question 35

How would you explain the diagnosis of osteoarthritis?

Answer 35

Osteoarthritis is the most common form of arthritis. It causes progressive degeneration of the affected joint. As this is a degenerative condition, there is no cure as such, but we can control it well with physiotherapy and pain relief medication.

Question 36

How would you explain the diagnosis of gout to a patient?

Answer 36

Gout is a condition which involves the deposition of small crystals in a joint. This irritates the joint and can cause redness, pain and swelling.

Question 37

What extra questions would you ask a patient presenting with symptoms suggestive of gout?

Answer 37

Systemic fever symptoms

Trauma to the joint

Diet - red meat, shell fish, alcohol

Question 38

What investigation and management plan would you suggest to a patient presenting with symptoms suggestive of gout?

Answer 38

Bloods (to rule out infection)
Joint aspirate
X-ray

Pain relief
Lifestyle modification - reducing certain foods and alcohol, weight loss and keeping hydrated

Prophylaxis if >2 attacks

Question 39

How would you explain the diagnosis of ankylosing spondylitis to a patient?

Answer 39

Ankylosing spondylitis is an inflammatory condition which affects the joints in the spine and in the back. It can also affect some of the tendons in your body and may cause problems with your eyes as well. It is a chronic condition, which means there is no cure as such, but we can manage it well with the appropriate treatment.

Question 40

How would you explain the investigation and management plan to a patient presenting with symptoms suggestive of ankylosing spondylitis?

Answer 40

Blood samples
MRI scan

Keep mobile
Physiotherapy
Pain relief

Question 41

What are the crucial questions not to forget when taking a history from a patient presenting with symptoms suggestive of a prolapsed disc?

Answer 41

Bladder and bowel control

Any loss of sensation or tingling in the upper thighs and around the groin area

*Explain that you are asking both of these questions as nerve compression can present this way

Trauma

Question 42

How would you explain the diagnosis if a prolapsed disc to a patient?

Answer 42

A slipped disc is when some of the soft material between the joints in your spin pushes out from the joint. As it does this it can press on some nerves and this can cause pain.

Question 43

What investigation and management plan would you suggest to a patient presenting with symptoms indicative of a prolapsed disc?

Answer 43

I think the best option today would be to refer you for an MRI scan. This should allow us to see where the problem is and how best to manage it.

A slipped disc usually resolves within a couple of months. In the meantime, i would suggest keeping mobile, i understand this is difficult when you are in pain, but keeping active will help speed up the recovery process.
The GP will discuss this with you further, but we can give you some anti-inflammatory pain relief which should help with your symptoms.

If anything gets worse or you are concerned about anything at all, please get back in touch.

Question 44

How would you explain the diagnosis of reactive arthritis to a patient?

Answer 44

Reactive arthritis is when a joint flares up after having an infection elsewhere such as a cold or a tummy bug. The joint isn’t actually infected it’s just a response that the body has.

Question 45

What investigations and management plan would you suggest to a patient presenting with symptoms suggestive of reactive arthritis?

Answer 45

Joint aspirate
Blood culture
X-ray
Urine and stool cultures (to rule out infections)

Most cases resolve by themselves within about 6 months, in that time you can take some pain relief to help with your symptoms. It may also be appropriate to consider some steroid treatment as well.

Question 46

How would you explain the diagnosis of fibromyalgia to a patient?

Answer 46

Fibromyalgia is a condition which causes generalised pain over the body. It’s often brought on by physical or emotional stress. The problem is with how the body interprets pain signals rather than a physical problem, and so the body misperceives that it is in pain.

Question 47

What extra questions/ topics are important not to miss when taking a history form a patient presenting with fibromyalgia?

Answer 47

Depression 
Poor sleep 
IBS - sore tummy, altered bowel habits 
Trauma 
Significant emotional stress

Question 48

What investigations and management plan would you suggest to a patient presenting with symptoms suggestive of fibromyalgia?

Answer 48

Physical examination (certain trigger points may indicate fibromyalgia) 
Bloods (to rule out other causes) 

Keep active 
Pain relief (atypical analgesia)

Question 49

How would you safeguard when taking a history from a patient presenting with fibromyalgia?

Answer 49

I understand that you are in pain, and that this isn’t easy for you. If you are feeling down or would like someone to talk to, please feel free to get back in touch and we can discuss things more, or give you a contact for some extra support.

Question 50

How would you explain the diagnosis, investigations and management plan for polymyalgia rheumatic to a patient?

Answer 50

Polymyalgia rheumatica is an inflammatory condition which causes stiffness of your muscles. It can also affect your blood vessels and cause and inflammatory problem.

I think it would be appropriate at this point to take a blood sample to allow us to see what’s going on.

The positive thing about this diagnosis is that it responds excellently to steroids. The GP will discuss this with you further, but i imagine they would see it appropriate to start you on steroids as soon as possible, If you improve very quickly while taking these, it indicates that this is the right diagnosis.

Question 51

How would you explain the diagnosis of polymyositis to a patient, and what would you suggest in terms of investigations and management?

Answer 51

Polymyositis is an autoimmune condition which causes weakness most commonly of the big muscles in your shoulder or hip.
To investigate for this i think it would be appropriate to do an examination to test your muscle power. It would also be appropriate to take some blood samples. The GP may discuss this which you further, but i think it may also be appropriate to do an investigation in which we pass a needle into the muscle to see how well i conducts a current.
In terms of management, there are a few different medications which we could consider. (Steroids, DMARDs, immunosuppression)

Question 52

How would you explain the diagnosis of dry age- related macular degeneration to a patient, and what would you suggest in terms of investigations and managements.

Answer 52

Macular degeneration is very common. It is a condition which causes a gradual decline in vision. Unfortunately there isn’t a cure, but we can do things to help you such as arranging reading aids and helping you with lifestyle changes that would optimise your health and help prevent further deterioration.

Question 53

How would you explain the diagnosis of wet macular degeneration to a patient, and what would you suggest in terms of investigations and managements.

Answer 53

I think you may have something which is called macular degeneration. This is a common problem which causes problems with vision. The GP will discuss this with you further but i think it it likely that we would want to examine your eyes today and then consider a referral to the ophthalmology clinic.
In terms of management, one of the most important things is to make sure you maintain a healthy lifestyle and don’t smoke, this can help prevent further problems in the future. There is also potentially the option for a treatment which is injected into the eye to help relieve your symptoms.

Question 54

How would you explain the diagnoses, investigations and management plan to a patient presenting with symptoms suggestive of cataracts?

Answer 54

Cataracts are a very common problem. They cause blurring of the vision and often just develop with the ageing process. I think it would probably be appropriate to examine your eyes today, and the GP will discuss this with you further, but i imagine they will consider referring you to the ophthalmology department. In terms of management, it is possible to remove cataracts by surgery, so this may potentially be something to consider.

Question 55

How would you explain the diagnoses, investigations and management plan for open angle glaucoma to a patient?

Answer 55

Glaucoma is a condition in which there is damage to the nerve which is important for your vision. This is usually caused by a build up of pressure within the eye. Unfortunately the visual loss can’t be regained but the GP may decide to put you on medications and arrange follow-ups to prevent any further loss of vision.

Question 56

What are some of the key symptoms of closed angle glaucoma?

Answer 56

Very painful 
Red eye 
Blurred vision 
N&V 
Seeing haloes

Question 57

What are some of the key symptoms of open angle glaucoma?

Answer 57

Gradual loss of peripheral vision

Painless

Question 58

What are some of the key symptoms of cataracts?

Answer 58

Painless
Gradual visual loss
Blurring of vision
Difficulty seeing at night and with driving

Question 59

What are some of the key symptoms of age related macular degeneration? (wet type)

Answer 59

Painless
Central visual loss
Straight lines appear curved and distorted

Question 60

What are some of the key symptoms of age related macular degeneration? (dry type)

Answer 60

Painless gradual visual loss 
Central vision affected first 
Straight lines appear curved 
Colours appear less vibrant 
Poor night vision

Question 61

How would you explain the diagnosis, investigations and management plan to a patient presenting with symptoms suggestive of otitis media?

Answer 61

Otitis media is an infection in the middle of the ear which causes redness and pain. Anyone can develop it but it tends to be more common in children. We can hopefully confirm the diagnosis with an examination of the ear.

Most cases clear by themselves but the GP may consider giving you some antibiotics if they think it is necessary. I think it would also be appropriate to give you some pain relief, which should make you feel much more comfortable over the next few days, however again this is something which the GP will need to confirm.

Question 62

How would you explain the diagnosis, investigations and management plan of otitis externa to a patient?

Answer 62

Otitis externa is an infection of the outer ear canal which can cause pain and some discharge from the ear. T confirm this i think it would be appropriate to do an examination of your ear to see if there are any obvious signs there. The GP will confirm this for you, but i think it can usually be managed with some ear drops. It’s also important to try and keep the ear dry as not drying the ears properly can be one of the reasons that this condition develops.

Question 63

How would explain the diagnosis, investigations and management plan of glue ear to a patient?

Answer 63

Glue ear is a condition in which there is a build up of fluid in the ear. This can cause some hearing loss and can therefore cause some delay in speech and language development. We can hopefully confirm this diagnosis by examining the ear. It often clears by itself in around 3 months, but i think what the GP will recommend is to review you after several months and see how things are going. If it hasn’t sorted itself out by then there are some surgical options which can be considered, such as the insertion of a small tube to allow the fluid to drain.

Question 64

How would you explain the diagnosis, investigations and management plan of cholesteatoma to a patient?

Answer 64

Cholesteatoma is a condition in which there is a build up of skin cells in the ear where they shouldn’t be. This can cause some discharge from the ear and can also cause hearing loss. It isn’t a skin cancer, but it should still be taken seriously and therefore the GP may consider referring you to the ENT department for further review.

Question 65

How would you describe the diagnosis, investigations and management plan of BPPV to a patient?

Answer 65

BPPV is a condition in which small crystals in the inner ear can displace and lodge elsewhere within the ear. The crystals move when you move your head and this is what can cause make you feel off-balance and like the room is spinning.
We can both investigate for and manage by the condition by doing a couple of simple procedures which involves lying you flat and moving your head into certain positions.. This should move the crystals back to their correct place and hopefully make you feel a lot better.

Question 66

How would you explain the diagnosis and management plan to a patient presenting with labyrynthitis?

Answer 66

Labyrinthitis is a condition which involves inflammation of a delicate structure in the inner ear which is called the labyrinth. It is usually caused by a viral infection and this can cause you to feel off-balance, experience some hearing difficulties and ringing in the ear. Unfortunately there is no treatment as such, but the condition does usually resolve within a couple of weeks. In the meantime it’s important to let yourself rest and drink plenty of water.

Question 67

How would you explain the diagnosis, investigations and management plan of meniere’s disease to a patient?

Answer 67

Meniere’s is a condition which affects the inner ear in which there is an excessive amount of pressure. This can cause you to feel off-balance, give you the sensation that the room is spinning and cause hearing loss or ringing in the ear. There is no cure for the condition, but the GP will discuss with you further as to what medications can be used to make the condition easier for you to manage.

Question 68

How would you explain the diagnosis of psoriasis to a patient?

Answer 68

Psoriasis is a skin condition which causes red scaly patches on the skin. It may also affect your nails and joints. It is a chronic condition, which unfortunately means that it can’t be cured, however with the appropriate management we should be able to get it under control.

Question 69

What management plan would you suggest to a patient presenting with symptoms suggestive of psoriasis?

Answer 69

There are several different things which we can consider to help you with your condition. The most important thing is to start by making sure you have a healthy lifestyle, things such as smoking and alcohol can make the condition worse, so where possible we would like to keep these to a minimum. The next best thing after this is to use a lotion every day to make sure that the skin is kept hydrated. The GP can discuss this with you further and hopefully sort out a prescription for that. The more that you use the creams and pay careful attention to your lifestyle, the less need there is for further treatment with things such as steroids.

Question 70

How would you explain the diagnosis and management plan of eczema to a patient?

Answer 70

Eczema is a common skin condition which usually causes an itchy rash. It may also be associated with other conditions like hayfever and asthma. It many children it clears up with age but we can also consider some treatments which should make you more comfortable. One of the most important things is to avoid any irritants, or anything which makes your skin worse. The GP will confirm all of this of you but i think it would also be appropriate to give you a lotion to apply every day to make sure that your skin is kept hydrated and healthy. The more you use these lotions, the less chance there is to require further treatment such as steroids.

Question 71

How would you safeguard when taking a history from a patient presenting with a skin condition?

Answer 71

If there are any signs that your skin becomes infected, such as any oozing or pus, or you feel unwell, come straight back in, this is something we would want to treat straight away.
(eczema)

If your skin problem is bringing you down or you just need someone to talk to, get back in touch and we can try to arrange something for you.

Question 72

How would explain the diagnosis of rosacea to a patient?

Answer 72

Rosacea is a skin condition which typically affects the cheeks, nose and forehead. It can be brought on by certain foods and stress aswell as some other triggers. It is a chronic condition, which means there is no cure as such, but with the right treatment it can be well managed.

Question 73

How would you explain the management plan to a patient presenting with symptoms suggestive of rosacea?

Answer 73

One of the most important things to do is to avoid any aggravating factors which worsen your skin condition, whether this is alcohol or spending to long in the sun e.t.c. The first step in terms of management is to use a topical antibiotic. The GP will confirm all of this, but i think we would recommend trying this for a while, and if it doesn’t work we can consider other options such as an oral antibiotic or even some laser therapy later down the line.

Question 74

What triggers are important to ask about when taking a history form a patient who is presenting with symptoms suggestive of rosacea?

Answer 74

Sunlight 
Alcohol 
Stress 
Spicy foods 
Have they used anything different on their skin recently

Question 75

How would you explain the diagnosis and management plan for acne?

Answer 75

Acne is a very common problem, a lot of people experience it at some point throughout their life. There are things which we can do to help get it under control. The doctor will confirm all of this, but the usual first step is to use a cream applied to the face or chest which should hopefully clear it up a bit. If this doesn’t work for you we can consider other treatments such as an oral antibiotic.

Question 76

How would you explain the diagnosis and management plan of croup to a parent/ carer?

Answer 76

Croup is a condition which can occur in babies and children. It is a viral infection of the upper airway which can cause a cough and some difficulty breathing. I understand that it can seem very alarming, but it does usually clear within a couple of days and doesn’t always need treatment. I would advise that you make sure you give your child lots of fluids, try to keep them sitting upright and comfort them if they are distressed, crying can make it worse.
The GP may also consider prescribing a single dose of steroid to help with the recovery.
If you do have any concerns or think that thins have got worse, or are not getting better, then please come back in.

Question 77

How would you explain the diagnosis and management plan for bronchiolitis to a parent/ carer?

Answer 77

Bronchiolitis is a condition which affects babies and young children. It is an infection of the lower airways which can cause a cough and wheeze.

I understand that it can seem very alarming, but it does usually clear within a couple of weeks. The GP will discuss this with you further, but sometimes it doesn’t require treatment, but admission to hospital might be necessary so a close eye could be kept on your child’s condition to make sure it improves.

Question 78

What would be the key symptoms that would suggest a diagnosis of croup?

Answer 78

Cough (worse at night)

Stridor

Fever

Runny nose

Question 79

What would be the key symptoms that would suggest a diagnosis of bronchiolitis?

Answer 79

Cough

High pitched expiratory wheeze

Hyper-inflated chest

Question 80

How would you explain the diagnosis and management plan for whooping cough to a parent/ carer?

Answer 80

Whooping cough is a bacterial infection of the lungs and airways which causes a cough which is usually worse at night and after feeding. It is a very infectious condition, and it’s therefore important to treat it. The GP will confirm if this is correct, but i think it would be appropriate to prescribe some antibiotics and keep a close eye on how things go. It may be necessary for admission to hospital to make sure everything is well controlled.

Question 81

How does measles present and what would you recommend in terms of management?

Answer 81

Measles is a type of viral illness which can be quite unpleasant. It is rare now due to the introduction of very effective vaccines. It can cause cold like symptoms, fever, rash and white lesions in the mouth.
Although it can be very unpleasant, it does usually pass within a week or so. In the meantime it is important to stay hydrated and take pain relief. It would be recommended to stay off work/ school/ etc until you are completely better.

Question 82

How does mumps present?

Answer 82

Mumps is a contagious viral illness which is rare now due to the introduction of very effective vaccines.
It presents as a painful swelling of the parotid glands which are just below the ears at the side of the face. It may also involve headache and fever.
It usually isn’t too serious, but it’s likely that the GP may want to do an examination and run some tests to rule out other things. Because it is contagious you should avoid contact with other people for at least 5 days after the glands swell.

Question 83

What are the symptoms of pyloric stenosis?

Answer 83

Projectile vomit
Constipation
Eager to feed/ hunger
Poor weight gain

Question 84

How would you explain the diagnosis of pyloric stenosis to a parent/ carer?

Answer 84

Pyloric stenosis is a condition in which there is a narrowing between the stomach and the intestines. This causes food to build up in the stomach to the point where it has nowhere to go. This is why it causes vomiting after feeding. It can be diagnosed by an US scan and is managed with a surgical procedure.

Question 85

What investigations/ management plan would you suggest to a parent/ carer with regards to pyloric stenosis?

Answer 85

The best investigation for this condition is an ultrasound of the stomach. In terms of management the best option is to consider a surgical procedure in which a small cut is made into the muscle between the stomach and intestines. This allows the passage of food stuff and should relieve the symptoms. I understand that the idea of surgery may seem alarming, but it is very important to do to make sure it doesn’t get any worse.

Question 86

How does malrotation/ volvulus present?

Answer 86

Projectile mild green vomit

3-7 days post birth

Question 87

How would you explain the diagnosis of malrotation/ volvulus?

Answer 87

Malrotation is a condition in which the bowel doesn’t sit where it should do inside the abdomen. If the bowel twists it can cut off blood supply and this is a condition known as volvulus.

Question 88

What investigations and management plan would you suggest for malrotation/ volvulus?

Answer 88

Abdominal x-ray

Surgery

Question 89

How would you explain the diagnosis of malabsorption?

What would you suggest in terms of investigations?

Answer 89

Malabsorption is a condition in which the body isn’t getting all the nutrients it needs. It can be caused by autoimmune conditions such as coeliac disease or by food intolerances and allergies.

We can investigate for the cause by taking a blood sample and potentially running some allergy tests. This something which the doctor will be able to advice you on further.

Question 90

How would you explain the diagnosis and investigations of allergic rhinitis to a patient?

Answer 90

Allergic rhinitis is a condition which involves inflammation of the inside of the nose. It’s caused by allergens like dust, pollen and animals. It is a very common condition and commonly presents with cold-like symptoms, such as having a runny nose or sneezing lots. This usually happens after you’ve been exposed to something you’re allergic to.

It’s usually possible to diagnose the condition based on what kind of things seem to trigger it. If you can’t pinpoint what it is, then you could possibly have some allergy testing done, this is something the GP will discuss with you further.

Question 91

How would you explain the management plan of allergic rhinitis to a patient?

Answer 91

The most important thing to do at this point is to try and avoid things which seem to make it worse. For example if it is dust you could try washing your bed sheets at a high temperature, or if it turns out to be a pet you could not let them in your room.
I understand that this can be difficult to do, so we could also consider anti-histamine tablets, which should give you some relief.
The GP will advise you further on all this, but i think these would be the most suitable steps for now. If things don’t improve it may be appropriate to add in a stronger medication, like a steroid nasal spray.